Streptococcal (strep) throat infection is very common. A 10-day course of penicillin is prescribed mainly to protect against the complication of acute rheumatic fever, which can occur approximately 20 days after streptococcal throat and cause damage to the heart valves. Cases of acute rheumatic fever have dropped dramatically in high-income countries. Newer antibiotics taken for a shorter duration, may have a comparable effect to penicillin taken for 10 days.
We summarized medical literature regarding the effect of two to six days of oral antibiotics (short duration) in treating children with streptococcal throat infection, compared with 10 days of oral penicillin (standard duration). We included 20 studies with 13,102 cases of acute group A beta hemolytic streptococcus (GABHS) pharyngitis. The short duration treatment resulted in better compliance but more side effects. All side effects were self-limiting: mostly mild to moderate diarrhea, vomiting and abdominal pain. Three studies reported the rate of long duration complications with no statistically significant difference.
Our study has several limitations. Firstly, only 3 out of the 20 included studies followed the participants for a sufficient duration to be able to study the prevalence of complications of GABHS pharyngitis. Although these three studies had a total of 8135 participants, results were too under-powered to draw any conclusions on differences in complication rates. This means our conclusion is not applicable in low-income countries where the prevalence of rheumatic heart disease is high. Another limitation is that the primary studies evaluated different antibiotics for variable durations (three to six days). Also, studies were of limited quality. Finally, although the shorter antibiotic duration appeared to be effective and more convenient, it is more expensive than the standard duration 10 days of penicillin. However, one must take into account the reality of patient behavior and the price of unsuccessful or incomplete therapy.
Three to six days of oral antibiotics for children with streptococcal throat infection is a safe treatment with a comparable effect to the standard duration of 10 days of penicillin. However, our results must be interpreted with caution in low-income countries where acute rheumatic fever is still a problem.